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布加综合征的活体肝移植:病例系列

Living-Donor Liver Transplantation for Budd-Chiari Syndrome: Case Series.

作者信息

Karaca C, Yilmaz C, Ferecov R, Iakobadze Z, Kilic K, Caglayan L, Aydogdu S, Kilic M

机构信息

Department of General Surgery, Izmir University of Economics, Faculty of Medicine, Izmir, Turkey.

Department of Liver Transplantation, Izmir Kent Hospital, Izmir, Turkey.

出版信息

Transplant Proc. 2017 Oct;49(8):1841-1847. doi: 10.1016/j.transproceed.2017.04.028.

Abstract

BACKGROUND

Venous reconstruction in living-donor liver transplantation for Budd-Chiari syndrome (BCS) has challenges because the grafts from living donors lack vena cava, and hepatic venous anastomosis must be performed on an already-thrombosed and/or stenosed inferior vena cava. Several techniques are described to overcome this problem, and we represent our experience with 22 patients.

METHODS

Medical recordings of 22 patients were retrospectively collected, and disease-specific data as well as recordings about surgical technique were analyzed.

RESULTS

Creation of a wide, triangular de novo orifice was the main method used for venous drainage, which was used in 19 patients. The remaining 3 patients had totally thrombosed vena cava; thus, direct anastomosis to the supra-hepatic portion of the vena cava was used in 2 patients and an anastomosis to the right atrium was used in 1 patient.

CONCLUSIONS

Venous reconstruction in BCS can be achieved without the use of patch-plasty, and the inferior vena cava can be safely resected in selected patients. Living-donor liver transplantation is a feasible option for the treatment of BCS, considering the scarcity of cavaderic donors.

摘要

背景

布加综合征(BCS)活体肝移植中的静脉重建存在挑战,因为活体供肝缺乏腔静脉,且肝静脉吻合必须在已形成血栓和/或狭窄的下腔静脉上进行。已有多种技术用于克服这一问题,我们介绍22例患者的经验。

方法

回顾性收集22例患者的病历记录,分析疾病特异性数据以及手术技术记录。

结果

创建一个宽大的三角形新开口是主要的静脉引流方法,19例患者采用了该方法。其余3例患者的腔静脉完全血栓形成;因此,2例患者采用直接与腔静脉肝上段吻合,1例患者采用与右心房吻合。

结论

BCS的静脉重建无需使用补片成形术即可实现,在选定患者中可安全切除下腔静脉。考虑到腔静脉供体稀缺,活体肝移植是治疗BCS的可行选择。

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